Current Thinking on Connecting Implants to Natural Teeth?

Just DONT, in simple terms that is the best advise. best of luck

I have found clinically that connecting teeth to implants in a bridge scenario, whether anterior or posterior, works quite well. Do not use a precision attachment or a temporary cement. Occlusion usually makes or breaks these type of cases, so eliminate the interferences to CR and have stable holding contacts that take into account the difference between the tooth and it's periodontal ligament and the implant without a ligament. Your second question regarding a pontic or pontics off an implant is more difficult to answer, since there are more variables. Dr. g

Do not treatment plan for implants to be connecting to natural teeth.

i did quite a few of them, always with a rigid connection and always the implant the most posterior connection ; often with a gold coping and the natural tooth, stopped then doing it [don't know why?, maybe because the cost is not that much different is include all the above] , but looking back over 10-15 years never had any problems with it. But my 1st choice would always be free standing implants!

My first choice is implant-implant connection, but I have been connecting natural teeth and implants for a long time now and had only one single complication in periodontally compromised situation. However, over 98% of those teeth are endo-treated and supplied with a post and core prior to splinting them with implants. Retrospectively, I believe this is a key point, since tooth-implant connection often results in tooth ankylosis. I always do rigid bridge connection, cement them with permanent cement (usually classic zink-phosphate) and carefully define occlusal contacts differently on tooth and on implant crowns both in maximum bite and slight bite force. Occlusion is extremely important in implant prosthodontics, and even more so in tooth-implant splinting. If you do it this way you should not have any problems.

The key with this question is long term results. Attaching implants to natural teeth is usually done to minimize costs. This needs to be explained to the patient. Placing an extra implant is usually the best way to treat the case. Also, you need to look at where and why you want to attach to a natural tooth. Most of the time the seal is not good enough on the natural tooth. Each case is different and you can not treat implants with a cook book approach. You need to engineer the case properly. It is also dependent on the plaque control of your patient also.

No problem, however place a coping (gold) over the natural abutments. Use a hard cement for the coping. I have been doing this for over 16 years with no problems. I have done this with blades, root forms and unilateral subperiosteal implants. The main thing is to respect the occlusion, width of occlusal table, have the patient use a night guard while sleeping and evaluate the occlusion on a regular basis!

There are many factors to be considered when engineering a combined tooth and implant case, the opposing dentition, condition of remaining teeth, bone volume and quality, pt health history, parafunctional habits,pt preferences and finances just to name a few. A well designed case can last as well as traditional fixed bridgework. A poorly designed case can fail as quickly as any other poorly designed case. When designing the case you must allow for movement of natural teeth due to the PDL and then the function on the implant supported portion. This can often be accomplished by the use of a stress breaker. When using a stress breaker the lever arm should be connected to the natural tooth portion of the bridge and rest on the implant portion. This allows the PDL to be exercised. Another method which has been successful utilizes gold copings on natural teeth. This protects the natural tooth from decay when the cement breaks down over the natural tooth and the case will likely need recementing over its lifetime. Careful attention to occlusion is the key to success.

I am new to implants so I haven't faced a similar situation. But on analysis of the question one comes to now that the patient desires to save money. But on analysis of the answers one can conclude that the patient is going to spend on a cost gold coping any way. So what's the point in putting one implant less? Might as well put an additional implant and sleep peacefully!

thats fine if the patient has the bone.... but sometimes when patient lacks bone then what ?

Implantology is not mathemathics! Yes- best of all is to leave implants alone (splint them ALWAYS when possible!). But in my modest experience so far I`ve had several cases, when natural teeth (without perio- problems had to support a fixed bridge together with implants, never so far had a problem). I totally agree with the colleague dr ACatic - planning is essential in those cases. If a tooth is stable, without perio problems- why not including it in a larger implant construction? Efforts must be made to allow for excellent cleaning around natural teeth (as around implants too), as a periodontally compromised tooth will compromise even the best implant treatment, leading to a prosthetic failure after all. Best of luck!

does the term "evidence based" mean anything to some of you? the age of the cowboy dentistry should be laid to rest. Keep in mind just because you got away with driving your car with your eyes closed on a deserted street a few times doesn't mean you should try it on a busy highway... ponder that for a bit instead of going on gut feeling and a lasso.

Well sorry to you naysayers, you can join implants to natural teeth and there is plenty of evidence to support that it is entirely viable. Stand alone implants are preferred but on occasion there is great benefit to the patient to bridge an implant to a natural tooth rather than attempt risky surgery. I have done this on about a dozen cases and have not seen any problem whatsoever over many years. There are some common sense guidelines which should be applied: • The implant abutment should be of substantial size and should be placed in type II bone to best withstand the increase in shear forces that can arise from this type of hybrid bridge system. • The pontic should have a short span, preferably only a single tooth, to minimize torque forces on the abutments. • The natural root abutment should have good stability, preferably with no mobility and the tooth should preferably be multi-rooted to minimize tooth displacement. • Both abutment connectors should have a rigid connector design. Nonrigid attachments should be avoided as they are associated with a greater incidence of root intrusion. • If telescopes or copings are used, avoid temporary cements; in particular, avoid the no-cement coping technique, as loss or absence of a rigid connection will induce the highest incidence of intrusion. • Use highly retentive cements with superior design features for retentive preparation at the abutment to resist cementation failure. • Eliminate or minimize unbalanced tooth contacts in excursive movements and in centric contact. • Consider bruxism as a risk factor; if present, manage bruxism with an antibruxism splint, preferably placed on the arch that contains the bridge.

i agree with above comment If the biomechanics are taken nto consideration this is not a problem The guidlines above are a good start I refer you all to Misch text Book Goes into the fine details of what can and cannot be done makes perfect sense DrS

Dr S, you are right. The biomechanics should be taken in to consideration. But Misch does not recommend connecting implants to natural teeth. And as far as I know, the evidence based consensus at this point is also against this idea.

There are two great advises you can get wen gettig int implants.. 1.- Dont place posterior mandibular implants in the same surical act of extracting or using a regional block like the Spix technique. 2.- Dont connect teeth to implants, you wil overload the implant without any reason and or you can get dental intrussion. In the end is a cantilever situation over the implant... not good

The first impant I placed was a blade in 1983. Number 5 was an abutment, 4 a pontic, 3 the implant abutment and 2 a cantilever pontic. This case is still in function and looks as good as the day I delivered the fixed bridge in '83. In 25 years I have had one case like this that failed.

I agree with Robert Brenham regarding long term success conecting teeth with blade implants (and blade implants only). This is because the osseointegration of the blades is different than root form; they develop a fibrous connective tissue similar to the periodontal ligament (blades used to be placed in function immediately).

I have placed and restored thousands of implants since 1991! My first case was distal root forms (CORE-VENT) abutted to a bicuspid with an overcoping. This case is still going strong, as well as other like cases- blades and root forms. I have only seen intrusion of natural teeth in journal articles, never clinically. However, do not abut implants to mobile teeth or place them next to mobile teeth and have said implant in full occlusion (should be out of occlusion). R. Hughes, D.D..S., FAAID, FAAIP, Dipl. ABOI/ID

addendum to prior posting: Teeth are usually the weak link in rehab cases combined with implants!

Dr. Hu, your comment is correct. However, in reality one can connect implants to healthy natural abutments without any consequences. I have only seen this a few times and only in lectures and journal articles. You have to remember to use copings on the natural abutments with a soft cement!